Healthcare Provider Details

I. General information

NPI: 1639673189
Provider Name (Legal Business Name): SEUNGJUN KIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST STE 401
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

800 E 28TH ST STE 401
MINNEAPOLIS MN
55407-3723
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number82142
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: